Outcomes of Combined Medical and Behavioral Treatments for Constipation Within a Specialty Outpatient Clinic

Chronic constipation is a common and challenging childhood problem. Effective treatment for chronic constipation and fecal incontinence includes a combination of medical and behavioral treatments. This study evaluates the outcomes associated with providing these treatments in a specialty outpatient clinic consisting of a nurse practitioner and behavioral psychologist. Fifty-seven patients were followed up for initial and follow-up appointments in this multidisciplinary chronic constipation clinic. In addition, 65% of the patients did not return after the initial visit; from this cohort, 21 patients (20%) were randomly selected and outcomes were derived by phone interview. Results showed a reduction in bowel accident frequency, abdominal pain, use of diapers, and perceptions of having constipation. In most cases, these outcomes were achieved after a single visit; however, a more extended treatment was required to achieve optimal benefits for patients who initially presented with frequent bowel accidents. These results suggest that a multidisciplinary clinic comprised of a nurse practitioner and behavioral psychologist provides an effective and efficient way to provide a combined treatment protocol for constipation in children. Future research should evaluate long-term effects of this intervention on constipation symptoms and overall health care utilization.